01162
Provider Identifiers
2003-08-22
Definition: This repeating field contains the provider_s unique identifiers such as UPIN, Medicare and Medicaid numbers. Refer to User-defined Table 0338 - Practitioner ID number type (Section 2.16.57) for suggested values.
Length≤100
4 components
| 1 | R | - | ID Number | |
| 2 | R | Type of ID Number | ||
| 3 | O | - | State/other Qualifying Information | |
| 4 | O | - | Expiration Date |